Kodiak Area Native Association (KANA) realized during the COVID-19 pandemic that they needed a laboratory information system (LIS) to automate manual test ordering and reporting and to create system-wide efficiencies. With Orchard’s LIS solutions, they were able to grow their lab and better serve the patients they care for across a wide geographical area.
KANA Offers Comprehensive Care & Community Services
KANA is a community health center with two locations and six remote village clinics in Kodiak, Alaska. They have provided healthcare and social services for Alaska Natives and communities throughout the Koniag region since 1966 with the goal of improving the health and well-being of their patients
Laboratory Quickly Grows Test Menu & Capabilities
Prior to the COVID-19 pandemic, the small lab at KANA performed waived testing and provider-performed microscopy, but COVID-19 brought about the need for rapid change. To address the pandemic, they shifted quickly and upgraded to a moderately complex laboratory to perform COVID-19 PCR testing. KANA’s lab grew from two employees in the medical department to a comprehensive laboratory department with a staff of 22.
Lessons Learned from the Pandemic
Addressing the pandemic necessitated some rapid changes to give their community the lab services they needed. KANA began seeing patients in-house only for urgent care. They used telemedicine for non-urgent visits. They built a lab team by pulling staff resources from everywhere available, including dental assistants, dental hygienists, and certified nursing assistant graduates, to help with COVID-19 drive-through collection and testing. Initially, the entire process was manual from test ordering to reporting.
Test results were tracked in a spreadsheet and later entered in the EMR. Between manual entry of results and double-checking for accuracy, the time for test reporting became enormous and the error rate was significant. The lab quickly realized the need for an LIS.
KANA Quality Improvement Study
Expanding and Increasing the Utilization of KANA’s Laboratory
United States Public Health Service Commander Ashley Frost, MHA, MLS(ASCP)CM, worked with her team at KANA to conduct a quality improvement study in March 2022. As laboratory director, she wanted to determine how to maximize the value of KANA’s lab and “provide greater access and improved lab turnaround times for existing and additional moderate complexity tests … for the treatment and management of common conditions of our patient population.” These results were presented to KANA’s Lab Quality Committee, Clinical Quality Committee, Health Services Advisory Committee, and Board of Directors. KANA’s analysis and subsequent improvement project to provide greater access and improved lab turnaround times resulted in selection and implementation of Orchard Software solutions. Figure 1 describes the laboratory goals that were set because of the study.
Orchard & KANA Partner
With a significant footprint in Alaska, Orchard Software was always a consideration for KANA’s newly expanded lab. KANA realized that with an LIS, they could eliminate manual processes and add to their in-house testing menu to better serve their patient population. KANA partnered with Orchard in August of 2020 and implemented cloud-hosted Orchard® Point-of-Care™ and Orchard® Outreach™ in 2021.
“We were fortunate to have experienced individuals at the higher levels that had the foresight to recognize both the flexibility and robust programming that Orchard offers. Orchard has been implemented in our remote locations, successfully allowing each clinic or hospital to grow as they need to,” CDR Frost said.
KANA Boosts Testing Menu with Orchard Implementation
KANA needed to rapidly increase its laboratory capabilities to respond to COVID-19. During this process, it became apparent that the lab’s current capabilities were inefficient due to manual processes that could be automated with an LIS.
After LIS implementation, data from September through December of 2021 revealed that five identified tests exceeded 90% in onsite test performance (See Figure 2). Post-implementation analysis of the critical lab tests from September to December 2021 identified that 84.6% of all laboratory tests are now performed in-house.
Orchard’s Solutions Bring Greater Efficiency & Quality
At KANA’s lab, efficiency and quality were the primary goals and expectations for their new LIS. “With COVID we were manually validating patient identities, entering orders and results, and manually reviewing for correctness,” Frost said. “The time spent was astronomical. The go-live of Orchard streamlined our COVID testing processes not only within our primary clinics, but our village clinics as well.”
Having an LIS integrated to instruments and the EHR greatly improved KANA’s processes because it automated test ordering, reviewing, and reporting. With their Orchard LIS solutions, they have eliminated manual entry—saving an enormous amount of time and greatly reducing errors.
KANA conducted a study that demonstrated their error reduction and other key metric improvements (See Figures 3 and 4). Automating label printing, performing quality control, and having the ability to create reports were other LIS features that helped to speed processes at KANA. “Interfacing our EHR and instruments to the LIS has been life-changing for us,” CDR Frost said.
Listed below are some of the top features within Orchard’s solutions that have helped KANA’s lab provide better patient care.
Cloud Hosting Takes Pressure Off IT Team
Being in a unique location with unpredictable weather, KANA was glad to have the option to host their LIS in the cloud. “Having our system remotely hosted and maintained is a big benefit for us because we can take that responsibility to maintain the system off of our IT team,” CDR Frost said.
Dashboard Offers Results, QC, Competencies, & Interfaces at a Glance
KANA’s Orchard LIS solution includes a dashboard that provides an overview of the lab’s operations, including quality control and patient results. Staff can track instrument interfaces and easily see which interfaces are offline or need attention. The dashboard also provides an overview of personnel certification statuses so that messages can be sent to end users that have expired certifications. “With the dashboard, all of the things that I really need are right there and it saves me time I would have spent digging through paper,” CDR Frost said. “With other LISs I have used, it seems like there are five clicks to get anywhere and the number of clicks equals time.”
Intuitive User Interface
Orchard’s products provide an intuitive user interface that makes it easy to figure out the next step; KANA’s Orchard laboratory information system is easy for non-lab trained staff to learn quickly. CDR Frost says that she has been able to create reports and navigate through the system with ease, replacing processes that previously involved “notebooks upon notebooks” of LIS instructions. “With Orchard, I’m able to go right where I need to. I can open up Admin Center, go to my reports, and access everything that I need to do without thinking about it anymore,” she said.
Easy Review of QC for Remote Sites
CDR Frost explained that with Orchard’s LIS solution, reviewing QC has never been easier. Prior to LIS implementation, the lab used a 3-ring binder to track and document QC review. Now a QC summary shows on the dashboard and is reviewed daily. “I can see QC that passed. I can select all and bulk approve. It’s just so much easier than it was before,” CDR Frost said. “And I can trust that the QC has been performed and that values are in before patient results are released.”
Competency and Certification Management Reduce Paper Usage
Replacing another set of binder notebooks, Orchard® Point-of-Care™ allows centralized tracking of user competencies. The system displays the certification status (certified, expired, expiring soon) for each operator. Certification documentation can be scanned and linked to the operator. Automating competency checklists to ensure certifications include all six elements of CLIA requirements for non-waived tests saves KANA’s lab time. Quizzes, QC, and test verification can be assigned, and the system is set up to meet the first six months’ competency followed by annual thereafter, as specified in the regulatory requirements.
Auto-verification Saves Time
The lab was able to implement auto-verification and reporting for negative COVID-19 results which saves a tremendous amount of time for their team. By streamlining COVID-19 testing, they were able to focus on the lab’s strategic goals to add more critical and high-volume tests to the testing menu to better align with patient needs. “Auto-verification helps us be super streamlined and standardized. I have peace of mind that we are reporting accurate results and that’s awesome,” CDR Frost said.
Working With the Orchard Team
When comparing with other vendors they have worked with, CDR Frost emphasized, “We like to think we work well with others, but what I can say from working with Orchard is that their attentiveness, when we are struggling or finding solutions that might be better, is substantially better than every other vendor that we’ve worked with. It’s really the Orchard team that has made this partnership so successful. Our ability to give and receive candid feedback has made our system work so well for us.”
Advanced Support—Working Together to Find Solutions
KANA has an advanced system administration agreement with Orchard that gives them access to a dedicated and proactive contact for support issues. CDR Frost explains that “[The system administration agreement] has been amazing. The people that we’ve been able to work with are very knowledgeable, and willing to listen and work with us—always looking for ways to make our system better.”
KANA’s lab plans to continue to grow and gain efficiencies using their Orchard laboratory information system solution to its maximum ability and find ways to support their patients and community.
“Orchard’s products have really met our expectations. With any question, complaint, concern, or opportunity, we have found Orchard to be incredibly receptive,” CDR Frost said. “We like to use our programming to the top of its capabilities and having a software program that is designed to be used by a lab has changed our perception of LIS/LIMS products.”